Patients could be asked to buy their own blood pressure monitors because only a minority of GP surgeries have home measurement devices, an expert has warned.

Professor Beevers

Gareth Beevers, a professor of medicine at City Hospital Birmingham, voiced concern after official draft guidance was published recommending patients suspected of having hypertension be sent home with special kits designed to monitor their blood pressure over 24 hours.  Studies have shown that readings taken over a whole day with 'ambulatory blood pressure monitoring' (ABPM) devices are more accurate than a series of spot checks in doctor's surgeries.

Up to a quarter of people experience a soaring pulse rate on entering a surgery, which is leading to many people being wrongly diagnosed with high blood pressure, according to the National Institute for Health and Clinical Excellence (Nice). The syndrome is known as "white coat hypertension".

But ABPM machines, which measure blood pressure at intervals and download the results to a computer for analysis, are expensive.  Prof Beevers, a trustee of the Blood Pressure Association, said: "Practices may need to spent £20,000 to £30,000 to buy these monitors and computer software."  He went on: "If you can't get 24-hour ABPM, a reasonable and nearly as good alternative is for patients to measure their own, using home blood pressure monitoring (HBPM)."  HBPM devices rely on patients to take and record their own measurements throughout the day, meaning they are affordable.  "Most patients can cope with taking their own measurements, and they can buy a simple machine for £10 to £15," said Prof Beevers.

Source: Daily Telegraph

Making sure you get an accurate reading from your blood pressure monitor.

A good way of ensuring that you are getting an accurate set of readings from your clinically validated home blood pressure monitor is to follow the guidance of the European Society of Hypertension.  These are simple, and, if you have been wondering if you are just suffering from “white coat” hypertension or are indeed in need of a lifestyle change then this is a good an accurate approach that will also be useful for your doctor.  I am assuming that you are using a clinically validated automatic blood pressure monitor and that you know how to use it.  If not, you can gets advice on purchasing a validated monitor and using it at www.expertsinbloodpressure.co.uk. 

The idea behind the European Society Guideline is to produce a number of blood pressure readings over a seven day period which then allows an average to be taken – giving a better idea of what your actual blood pressure is that when a single measurement is taken in a surgery, at the pharmacist or at home.

Choose a time, both in the morning and the evening, when you know you are likely to be able to take the time to relax and take your blood pressure.  These time do not have to be exact but can be in a “window”, so for instance between 7am and 9am and then between 7pm and 9pm.  If your blood pressure monitor has a memory then great, but if not – and you might want to do this anyway, make sure you have a pen and piece of paper ready.

Every day for 7 days, take your blood pressure twice in the morning and twice in the evening – noting down the results – remember to make sure you are relaxed, using a clinically validated monitor and following the manufacturer’s instructions.  At the end of the week your readings may look something like this:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning	142/88	145/90	140/90	132/82	145/90	140/90	132/82
	137/85	140/87	132/78	140/78	140/87	132/78	140/78
Afternoon	140/86	138/84	133/76	128/76	138/84	133/76	128/76
	138/82	135/80	135/81	129/78	135/80	135/81	129/78

You can now start to work out what your average blood pressure is.  First, disregard the readings you took on the first day.

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning	142/88	145/90	140/90	132/82	145/90	140/90	132/82
	137/85	140/87	132/78	140/78	140/87	132/78	140/78
Afternoon	140/86	138/84	133/76	128/76	138/84	133/76	128/76
	138/82	135/80	135/81	129/78	135/80	135/81	129/78

You now have a total of 24 reading that you have token at specific times through the week.  Using these numbers you can get an average of your blood pressure in the morning, in the evening and as a whole.  If you are taking medication for your blood pressure, it is worth noting down when you take it.

For my readings I can calculate the following.  The average morning reading was 138/84, the average evening reading was 133/79 and the average for the whole week was 135/81.  This will be a reading that is more accurate than a one off taken in the week and will allow your GP and yourself to get a much better picture of your blood pressure.

Your GP or clinician might want you to have a 24hr ABPM test, but may well be satisfied with these figures.  And if you do have white coat hypertension with high readings when you visit the surgery, this approach will also show that.

Blood pressure to be measured at home to cut down on misdiagnosis

Patients suspected of having high blood pressure will get another check at home because of fears that nerves from being at a GP surgery may be leading to too many people being diagnosed.  So-called white coat hypertension is thought to affect a quarter of people, the NHS advisory body NICE said.  It is proposing that patients with high readings in a clinic are then monitored at home to ensure a correct diagnosis.
The guidance for England and Wales will now be consulted on.  Final recommendations are not expected until the summer, but already health experts have welcomed the move.  Professor Gareth Beevers, from the Blood Pressure Association, said: "This should aid correct diagnosis. The association has recommended patients take their blood pressure at home for a number of years now, though it's essential that the blood pressure monitor has been clinically validated."

More than 8m people are registered as having high blood pressure, which could mean as many as 2m people have been misdiagnosed because of nerves.  Misdiagnosis can lead to patients being put on drugs - and therefore suffering side effects - unnecessarily.  The solution being put forward by the National Institute of Health and Clinical Excellence involves ensuring patients who have had a high blood pressure reading at their GPs get checked at home.

The body said this could either be done with an inflatable arm cuff that takes regular readings over 24 hours or getting a health professional to visit someone in their own home to take another reading manually.

Source: BBC Online

"Watch" device could revolutionise blood pressure monitoring

A device which can be worn like a watch could revolutionise the way blood pressure is monitored in the next few years, scientists say.  Researchers at the University of Leicester and in Singapore have developed a device to measure pressure in the largest artery in the body.  Evidence shows it gives a much more accurate reading than the arm cuff.  The technology is funded by the Department of Health and backed by Health Secretary Andrew Lansley.  It works by a sensor in the watch recording the pulse wave of the artery, which is then fed into a computer together with a traditional blood pressure reading from a cuff.  Scientists are then able to read the pressure close to the heart, from the aorta.

Professor Bryan Williams, from the University of Leicester's department of cardiovascular sciences at Glenfield Hospital, said: "The aorta is millimetres away from the heart and close to the brain and we have always known that pressure here is a bit lower than in the arm.  "Unless we measure the pressure in the aorta we are not getting an appreciation of the risks or benefits of treatment."  He said the device would "change the way blood pressure has been monitored for more than a century" and he expected the technology to be used in specialist centres soon, before being "used much more widely" within five years.  "The beauty of all of this is that it is difficult to argue against the proposition that the pressure near to your heart and brain is likely to be more relevant to your risk of stroke and heart disease than the pressure in your arm," he said.  But it was important to ensure the new device was as small as possible to encourage clinicians and patients to use it, he added.

The research work was funded by the Department of Health's National Institute for Health Research (NIHR).  The NIHR invested £3.4m, with a further £2.2m of funding coming from the Department of Health, to establish a Biomedical Research Unit at Glenfield Hospital in Leicester.  The university collaborated with the Singapore-based medical device company HealthSTATS International.

Dr Choon Meng Ting, chairman of HealthSTATS, said: "This study has resulted in a very significant translational impact worldwide as it will empower doctors and their patients to monitor their central aortic systolic pressure easily, even in their homes and modify the course of treatment for blood pressure-related ailments."

Mr Lansley said the device was "a great example of how research breakthroughs and innovation can make a real difference to patients' lives".

Source: BBC Online

Adherence therapy improves outcome in high blood pressure

Patients with high blood pressure would benefit from a series of personal advice sessions on their medication, say UK researchers.  Writing in the Journal of Human Hypertension, they said many of the 10 million people with the condition in the UK fail to take their medication.  The study showed a 14% reduction in blood pressure when people took part in "adherence therapy".  The British Heart Foundation said the findings should not be ignored.  High blood pressure, known as hypertension, is one of the leading causes of heart disease and stroke.  It can be treated with medication, but the authors claim that half of patients do not take their medication correctly.

Issues such as worries about side effects, a lack of motivation to take drugs and not following the correct instructions were identified.  The team at the University of East Anglia followed 136 patients in Jordan. Half continued to take their medication normally while the other half attended 20-minute face-to-face sessions weekly for seven weeks, in which patients were given tailored advice.  The patients given adherence therapy took 97% of their medication, while those who continued normally took only 71%.

On average, systolic blood pressure dropped by nearly 14% from 164.5mm Hg to 141.4mm Hg.  Professor Richard Gray at the School of Nursing and Midwifery at University of East Anglia, said: "Our findings suggest a clear clinical benefit in these patient-centred sessions.  "Tackling the widespread failure to take medication correctly would lead to a major reduction in stroke and heart disease. If adherence therapy were a new drug it would be hailed as a potentially major advance in hypertension treatment."

Source: BBC